• Users Online: 24
  • Print this page
  • Email this page
Export selected to
Endnote
Reference Manager
Procite
Medlars Format
RefWorks Format
BibTex Format
  Most popular articles (Since August 04, 2020)

 
 
  Archives   Most popular articles   Most cited articles
 
Hide all abstracts  Show selected abstracts  Export selected to
  Viewed PDF Cited
ORIGINAL ARTICLES
Prevalence of Common Geriatric Giants among Patients attending Geriatric Clinic of a Tertiary Care Hospital
Syed Mohammed Masood, Prabha Adhikari
April-June 2020, 16(2):68-70
DOI:10.35262/jiag.v16i2.68-70  
Objectives: To study the prevalence of Geriatric giants among elderly attending Geriatric clinic of YMCH and to study the various factors (like Age, gender, co-morbidity, etc.) associated with these Geriatric giants. Method: This retrospective study was conducted in a tertiary care referral centre, from the year 2018 to 2019, Ethics committee approval was taken wide letter no. YEC-1/29/2020 (Protocol YEC2/162). Two hundred two geriatric patients, presenting to the geriatric clinic with geriatric giants, with various co-morbidities, their data was recorded. Falls in the previous year and urinary incontinence were recorded. Polypharmacy is considered as concurrent use of more than four drugs. Diagnosis of dementia and depression was conducted according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition diagnostic criteria. All the proportions were expressed as percentages; mean ± SD were used for Numerical Data. Factors such as age group, gender, morbidity index (number of morbidity present) which are related to geriatric giants were assessed using the Chi-square test. Results: The frequency of urinary incontinence was 75.7%, depression was 69.3%, falls were 67.3%, dementia was 47.5%, and polypharmacy was 33.6%. When all the participants were divided into four groups age-wise, respectively (60-69, 70-79, 80-89, 90-99 years), all syndromes were significantly increased with age. While a significant number of cases in the 60-69 years age group did not have any syndromes, more than 50% of cases in ≥80 years had more than three geriatric syndromes simultaneously. Conclusion: The frequency and coincidence of geriatric giants, except for polypharmacy, increases with age. Therefore, clinicians other than the geriatricians taking care of older people should be aware of these syndromes as well as their treatment mechanisms.
[ABSTRACT]   Full text not available  [PDF]
  26 5 -
REVIEW ARTICLES
Polypharmacy in Elderly: Overview, Prevalence and Psychiatric Perspectives
Priya Sharma, P Khuda, NL Gupta
April-June 2019, 15(2):83-89
DOI:10.35262/jiag.v15i2.83-89  
Introduction: Ageing is a natural phenomenon that is accompanied by a cascade of unwanted and unintended circumstances or problems that are always undesirable but not still avoidable. Polypharmacy or irrational use of medicines is one of the many issues that may affect any age group but mostly affects the geriatric population. Since ageing is usually associated with several co-morbities. elderly are exposed to polypharmacy to greater extent, Lack of knowledge about the outcomes of polypharmacy adds to the suffering of elderly due to adverse drug reactions caused by drug interactions. Aim: The primary objective of the present study is to assess the prevalence of polypharmacy along with its association with psychiatric problems and how they influence polypharmacy. Methods: A literature review of electronic databases utilizing the search terms polypharmacy, polypharmacy in elderly, polypharmacy and ageing, multiple medications, inappropriate medication and prescribing cascade etc. for the period from 2010 to 2018 was done. The search was supplemented with online site searches of relevant medical, health and pharmaceutical journals. Also, literature comprising of original articles, and case studies were studied to identify articles which correspond to various definitions, causes, types of polypharmacy etc. The priority of search was geriatric pharmacy. Thus, the studies or the articles matching the geriatric age group were considered, and adequate data was extracted. A specific protocol regarding the sectioning of search like relevant data & irrelevant data was then incorporated to collect the most suitable and the authentic material for the review. Results: The aged population practice polypharmacy more in comparison to other age groups. Psychiatric illnesses further, enhances the polypharmacy. Conclusion: The findings suggested that polypharmacy is associated with the worsening of the health of the elderly due to its positive association with mental health problems.
[ABSTRACT]   Full text not available  [PDF]
  26 4 -
ORIGINAL ARTICLES
‘TIME IS BRAIN’ for Haemorrhagic Stroke Secondary to Warfarin Therapy in the Elderly
A Shabir
October-December 2016, 12(4):169-171
Intra-cerebral haemorrhage (ICH) is a rare complication of warfarin that is life-threatening and requires emergent treatment. Also, as ICH is unpredictable, large cohort studies are not possible especially in elderly patients. Treatment will continue to be based on case series and clinical experience. We present observational study of 4 cases of elderly patients with haemorrhagic stroke secondary to warfarin therapy with supratherapeutic INR. All patients received 10mg IV Vitamin K and 4 factor Human Prothrombin Complex Concentrate (Octaplex) for warfarin reversal. Of the 4 patients, 2 patients had good clinical outcome due to prompt reversal of INR with octaplex, while the other 2 patients had fatal outcome due to delay in warfarin reversal. Our study though small reiterates, as ‘Time is Brain’ in ischaemic strokes, likewise it holds true for haemorrhagic strokes. Larger trials are required to assess time for "door to reversal" similar to "door to needle" in stroke thrombolysis.
[ABSTRACT]   Full text not available  [PDF]
  26 3 -
REVIEW ARTICLE
Anemia in Elderly: A Review
Shaurya Mehta, Laxmi Kant Goyal, Ramkesh Parmar, Girdhari Lal Dhayal, Gunja Jain
April-June 2018, 14(2):74-78
Anemia is common among elderly and is associated with increased morbidity and mortality in this vulnerable age group. Anaemia hampers functional capacity and cognition, increases risk for frequent falls, frailty, dementia, hospitalization, mortality and mobility and ultimately affects the quality of life. Anemia in elderly is divided in three major types: nutritional deficiency, anemia of chronic disease including chronic renal disease and unexplained anemia. A high index of suspicion is required to manage anemia in elders. The symptoms (easy fatigue, decrease appetite, pallor) are usually taken as consequences of advance age. The onset of signs and symptoms are insidious and elders adjust their routine activities to the remaining physical capabilities and physiological adaptations. Anemia may present as worsening of associated disorder like worsening congestive heart failure, cognitive impairment, dizziness and apathy. The evaluation of anemia in elderly involves complete history including dietary, medical illness and medication history and through physical examination to detect any sign suggestive of etiology followed by further investigations accordingly. The treatment of anemia depends on its etiology and severity. In severe anemia, red cell transfusion is required along with treatment of underlying etiology. In unexplained anemia, eryth-ropoietin replacement in higher dose than usual may be needed due to blunted response to erythropoietin. Anabolic steroid supplementation is also beneficial in elderly with anemia.
[ABSTRACT]   Full text not available  [PDF]
  26 3 -
ORIGINAL ARTICLES
Relevance of ‘Vanaprastha’ of the Vedic Age at Afternoon Stage of Life at Present Global Age : A Perspective
Harasankar Adhikari
October-December 2016, 12(4):179-182
There is two parts in life- forenoon and afternoon. The afternoon part of life indicates the life at post retirement. At the afternoon stage of life, individual usually follows the rules of renunciation and detachment which the Vanaprastha of the Vedic Age directed. But at present global age, the elderly population lead a highly consumerised life. The present paper attempted to explore the above differences in the lives of elderly. For this purpose 100 elderly population of 60-70 years of age living at Kolkata Metro were studied. From this study, it revealed that majority of them was suffering from various problems (physical and mental). They used to follow highly consumerised life. While a little portion of them lived with happiness because they were practicing the rules of Vanaprastha and they led a simple living with renunciation. They used to practice a spiritual living. So, it might be a path of happy aging and acceptance of death.
[ABSTRACT]   Full text not available  [PDF]
  24 4 -
Factors Associated with the Outcome of Older Patients Admitted in Geriatric Intensive Care Unit
D Thangam, S Deepa
April-June 2019, 15(2):53-58
DOI:10.35262/jiag.v15i2.53-58  
Objective: To determine the factors associated with the outcome of older patients admitted in Geriatric Intensive Care Unit. Materials and Methods: This cross-sectional, observational study was conducted in the Geriatric Intensive Care Unit of the Department of Geriatric Medicine, Madras Medical College, Chennai. one hundred and seventy two patients, aged 60 and above, admitted in the Geriatric ICU during the period of 6 months, from January 2017 to June 2017, were selected to participate in this study. Data regarding age, sex, number of comorbidities, major organ system involved, duration of stay and procedures underwent in the ICU were collected and analyzed. Results: Out of the 172 samples, 92 were males, and 80 were females. The mean age of the study population was 70.1 ± 8.3 years. We found no association between age and survival (p=0.581), gender and survival (p=0.298). 30.2% of the samples who expired had four comorbidities. We found a statistically significant association between the number of comorbidities and outcome (p<0.008). Around 44 patients (25.6%) had respiratory problems, and it was the commonest cause of admission to ICU in this study. We found no association between major system involved and outcome (p=0.089). Sixty of the study participants (34.9%) needed mechanical ventilatory support. We found a statistical significance between procedure underwent and outcome (p<0.001). 57.5% of the study participants stayed in the GICU up to 1 week. We found a statistical significance between the duration of stay and outcome (p=0.022). In this study, 71.5% of the study participants survived, 3.5% of them went against medical advice, and 25% of them expired. Conclusion: In this study, the outcome of older patients admitted in Geriatric Intensive Care Unit depended on the number of preexisting comorbidities, length of stay and procedure underwent during the ICU stay but not the chronological age. In this study, only one in four died after undergoing treatment in the Geriatric Intensive care unit. Geriatric intensive care services can improve the outcome of older patients admitted with a critical illness.
[ABSTRACT]   Full text not available  [PDF]
  24 4 -
Caregiver Burden among the Caregivers of Older Adults with Palliative Care Needs
Khojji Humera, Sathiq Ali, Shruthi Bhat, Prabha Adhikari
April-June 2020, 16(2):63-67
DOI:10.35262/jiag.v16i2.63-67  
Objective: To examine caregiver burden among caregivers of hospitalised geriatric patients with palliative care design. Method: Caregivers of 330 geriatric patients with various chronic end-stage diseases were assessed using BSFC-s questionnaire. Results: Majority of caregivers were spouses (26%). The caregiver burden across the categories was more than 60% across all the questions asked in the BSFC-s questionnaire. Maximum in the caregiver with end-stage renal disease (60.3%) and a minimum of frail elderly (50.2%). Conclusion: Caregiver burden was common in caregivers of geriatric patients with end-stage chronic diseases. The burden was associated with the caregiver's report of need for greater help with daily tasks but not with objective measures of the patient's need for assistance, such as symptoms or functional status, suggesting that burden may be a measure of the caregiver's ability to adapt to the caregiving role.
[ABSTRACT]   Full text not available  [PDF]
  24 4 -
REVIEW ARTICLES
Frailty - A Systematic Review
M Velmurgan, A Goel
April-June 2020, 16(2):71-82
DOI:10.35262/jiag.v16i2.71-82  
Full text not available  [PDF]
  22 6 -
BRIEF COMMUNICATION
Cognitive Impairment and Dementia in Geriatric Population: Role of Clinical Laboratory
Abhik Banerjee, Gopa Haldar Das, Rajarshi Sil
April-June 2019, 15(2):79-82
DOI:10.35262/jiag.v15i2.79-82  
Mild cognitive impairment is an intermediate stage between the expected cognitive decline of normal ageing and the more serious decline of dementia. Dementia is typically diagnosed when acquired cognitive impairment has become severe enough to compromise social and/or occupational functioning. The elderly are at much greater risk for cognitive impairment. Unfortunately, most cases of cognitive impairment without apparent dementia go undetected and thereby untreated in primary care. Clinical diagnosis supported by appropriate use of diagnostic tests and biomarker is essential to improve the quality of life in these patients, In this article, we discussed the role of clinical laboratories in the diagnosis of cognitive impairment and dementia in the geriatric population.
[ABSTRACT]   Full text not available  [PDF]
  24 3 -
CASE REPORT
Geriatric Anaesthesia for Centenarians- A Challenging, Learning Experience!
Uma Hariharan, Vijay Kumar Nagpal, Devang Bharti, Shubhi Singhal Bharti
April-June 2019, 15(2):75-78
DOI:10.35262/jiag.v15i2.75-78  
With improving healthcare facilities, the geriatric population in India is on the rise. Anaesthesia in the geriatric age group poses many challenges to the peri-operative physician because of the decreased functional reserve and various comorbidities associated with advanced age. In addition to that, there is greater risk of post-operative cognitive dysfunction and delirium. Anaesthesia in patients above 100 years is a sub-speciality in itself, with several special considerations. We, hereby present the case of a 102-year-old female patient with severe aortic stenosis posted for left-sided dynamic hip screw fixation on an emergency basis under low dose, unilateral spinal anaesthesia, supplemented with slow and graded epidural anaesthesia.
[ABSTRACT]   Full text not available  [PDF]
  24 3 -
ORIGINAL ARTICLES
The Efficacy and Safety of Narrowband Ultraviolet B Phototherapy in Geriatric Patients: A Retrospective Study
SN Yusharyahya, L Legiawati, R Astriningrum, V Chandrakesuma
April-June 2019, 15(2):59-65
DOI:10.35262/jiag.v15i2.59-65  
Background: Skin diseases can be one of the factors affecting the quality of life of the growing elderly population. In treating various dermatoses in the elderly, structural and physiological changes of the skin due to ageing need to be considered. Phototherapy has been proven to be a valuable modality for many skin diseases in adults. However, there is currently no study evaluating the use of phototherapy to treat skin diseases in geriatric population in Indonesia. Objective: To learn the efficacy and safety of narrowband ultraviolet B (NB-UVB) phototherapy in geriatric patients. Methods: A retrospective study using data from medical records of patients aged 60 years and above that received NB-UVB phototherapy in Dermatovenereology Clinic at the Dr Cipto Mangunkusumo National General Hospital in 2014–2018. Results: From 34 included patients, 21 (61.7%) patients had psoriasis, 9 (26.5%) had vitiligo, and 5 (14.7%) patients had other dermatoses. Psoriasis Area Severity Index (PASI) 76% was achieved by 52.4% psoriasis patients with a median of 22 sessions and cumulative dose of 26.6 J/cm2. Initial repigmentation was seen in 100% of vitiligo patients starting from a median of 6 sessions and a cumulative dose of 1.5 J/cm2. The side effect of erythema presented in 10 (47.6%) patients, with an event rate of 1.48% per session. Severe erythema was experienced by one vitiligo patient requiring a delay in phototherapy session. Conclusion: Phototherapy is a safe and effective modality for the geriatric population with various skin diseases, using doses and frequency similar to those of adult patients.
[ABSTRACT]   Full text not available  [PDF]
  24 3 -
Sarcopenia and its Association with Geriatric Syndromes and Quality of Life in Older Indian Outpatients - A Cross-sectional Pilot Observational Study
Sunny Singhal, Gevesh Chand Dewangan, Rishav Bansal, Ashish Datt Upadhyay, Sada Nand Dwivedi, Chandan Jyoti Das, Prasun Chatterjee, Aparajit Ballav Dey, Avinash Chakrawarty
April-June 2019, 15(2):66-74
DOI:10.35262/jiag.v15i2.66-74  
Background: Despite the huge clinical impact of sarcopenia, there is very little to no data from Indian subcontinent regarding sarcopenia in older adults. We conducted this study to assess the frequency of sarcopenia in Indian older outpatients and its characteristics and associations with various geriatric syndromes and quality of life in Indian older adults. Methods: 100 participants above the age of 65 years were recruited from the outpatient department of Geriatric Medicine of a tertiary care hospital in India. Muscle mass, muscle strength and physical performance was measured by DXA scan (Dual Energy X-ray Absorptiometry), hand-held dynamometer and 4 m gait speed respectively. Sarcopenia was identified using an Asian working group for sarcopenia (AWGS) criteria. Many geriatric syndromes such as osteoporosis, dementia, depression and malnutrition were assessed using DXA scan (Dual Energy X-ray Absorptiometry), HMSE (Hindi Mental State Questionnaire). GDS-5 (Geriatric Depression scale - 5 item questionnaire) and MNA (Mini Nutritional Assessment) respectively. Quality of life was assessed using the OPQOL-brief questionnaire. Results: The prevalence of sarcopenia in our study population was 53% (49.3% in males, 61.3% in females). Hypothyroidism, neurological disease and osteoporosis were the only comorbidities found to be positively associated with sarcopenia. Among geriatric syndromes, nutrition and cognition were negatively associated with sarcopenia. Sarcopenia was also negatively related to the quality of life. Multivariate stepwise logistic regression analysis showed that osteoporosis (OR: 5.43; 95% CI: 1.57-18.81: p-value: <0.01) was significantly associated with sarcopenia. Conclusion: Sarcopenia was common among Indian older outpatients with increased risk of geriatric syndromes and poor quality of life, therefore, a regular sarcopenia assessment may be considered in elderly patients.
[ABSTRACT]   Full text not available  [PDF]
  24 3 -
Echocardiographic Findings and Cardiovascular Profile of the Very Old Indian Population
Pramod Kumar, Rishav Bansal, Rakesh Yadav, Sada Nand Dwivedi, Prashun Chatterjee, Aparajit Ballav Dey
April-June 2020, 16(2):49-55
DOI:10.35262/jiag.v16i2.49-55  
Background: Age-related changes in the cardiovascular system are significant, increasing the risk of cardiovascular diseases (CVDs) in older adults. CVDs are currently the leading cause of mortality among older Indian adults, yet very few studies are presently available evaluating the older adults for CVDs and risk factors. We aim to assess the very old adults for the prevalence of CVDs and risk factors using non-invasive assessment tools. Methodology: This hospital-based cross-sectional study included 200 adults aged 75 years and above, visiting a tertiary care hospital in India. They underwent routine clinical evaluation, a comprehensive geriatric assessment and detailed cardiovascular evaluation using non-invasive tools like echocardiography and blood investigations. Results: The overall prevalence of CVDs in this population was 76%. Among the cardiovascular risk factors, hyperhomocysteinemia was present in 83.5%, hypertension in 59.5%, dyslipidemia in 41.5%, sedentary lifestyle in 35%, and obesity in 30.5%, and Diabetes Mellitus in 24.5%. In echocardiographic assessment, valvular dysfunction was present in 33% of the population, though moderate to severe valvular disease was seen in 6.5%. Left ventricular diastolic dysfunction was seen in 81%, systolic dysfunction in 10% and pulmonary hypertension in 5% of the subjects. Conclusion: The very old adults had significant age-related changes in echocardiographic assessment, along with the high prevalence of cardiovascular diseases and risk factors. These findings should encourage physicians to screen the very old adults for cardiovascular risk factors and diseases, for their early identification and effective management.
[ABSTRACT]   Full text not available  [PDF]
  24 3 -
A Study on Hyponatremia in Critically Ill Geriatric Patients
R Maloo, KC Jain
October-December 2016, 12(4):172-178
Background: Hyponatremia is a condition when serum sodium is <135 meq/L and is considered severe when <125mEq/l. It can be due to abnormal sodium or water balance and is the most common electrolyte disorder occurring in critically ill patients and particularly so in the elderly. Aims: Present study aims to ascertain etiological factors, frequency and outcome of hyponatremia in critically ill geriatric patients and describe its clinical manifestations. Methods: This observational study was conducted in an intensive care unit of a tertiary care hospital of Rajasthan on 100 geriatric patients over a period of 1 year. Observation: In this study 62 males and 38 females were admitted with hypopnatremia with 25% having mild and 67% moderate hyponatremia; of which 58% were symptomatic having lethargy (34%) and postural dizziness (27%)as the common clinical presentation. Hypertension(57%) and diabetes (43%) were frequent comorbities while CCF (40%) followed by drugs (16%) were the common etiologies. Fluid restriction (63%) was the major treatment followed by diuretics (23%), normal saline (14%) and hypertonic saline (5%) with an overall mortality of 10% unrelated to the severity of hyponatremia at presentation. Conclusion: Hyponatremia is a significant cause of morbidity and mortality in critically ill geriatric patients and needs special consideration to decrease the ICU stay and associated morbidity.
[ABSTRACT]   Full text not available  [PDF]
  24 3 -
A Study of Dry Eye Disorder in Elderly Persons of Western Rajasthan
Avisha Mathur, Arvind Chauhan
April-June 2016, 12(2):48-54
Introduction: Dry eye syndrome is one of the most frequently encountered ocular condition and is a common cause of discomfort especially in the elderly population. It has a multifactorial etiology, which, in most cases, is always chronic and progressive. Material and Methods: This study was conducted from January 2015 to December 2015 and total 108 patients of more than 50 years age group were enrolled. It was a non randomized observational study in which all patients attending outdoor of department of Ophthalmology at MDM Hospital, Jodhpur with features of dry eyes syndrome were enrolled after receiving informed written consent. Results: Dry eye was more common in females (63.89%) in comparison to males (36.11%). Seventy eight percent of patients suffering from dry eye were above 60 years of age. 67.59% of dry eye patients were from rural areas. Most frequent complaint in patients suffering from dry eye was feeling of grittiness and soreness in eyes (80.56%). Next most frequent complaint was redness of eyes in 68.52% of cases followed by burning sensation in eyes (66.67%). Dry climatic condition was present for 100 percent of patients. Evidences suggestive of meibomian gland dysfunction were present in 63.89% of patients. History of cataract surgery by phacoemulsification and diabetes were present in 49.07% and 44.44% of patients respectively. Among symptomatic females, 34.26% patients were postmenopausal. Conclusions: Dry eye disorders are more common in elderly females. Most frequent complaint in patients suffering from dry eye was feeling of grittiness, redness and burning sensation in eyes. Dry climatic conditions, meibomian gland dysfunction, previous eye surgery, diabetes mellitus, long term antihistaminics and topical anti glaucoma drugs were most important risk factors for causing dry eyes in our study.
[ABSTRACT]   Full text not available  [PDF]
  24 3 -
Reciprocal Expression of Myostatin and Vitamin D Receptors in Sarcopenia
Ghada M Gamal El- din, Amal Mansour, Randa Ail Labib, Sarah A Hamza, Fawzia Khalil
April-June 2017, 13(2):52-61
Background: Sarcopenia is the loss of skeletal muscle mass and strength or/and performance that occurs in concert with biological aging. Objectives: To evaluate both myostatin (MST) and vitamin D3 receptor (VDR) genes expression in Egyptian adults with their relation to each other and muscle state. Methods: Two groups were involved; group A of sarcopenic patients and group B of non-sarcopenic subjects. Multiplex quantitative RT-PCR for MST and VDR mRNA in the peripheral lymphocytes of sarcopenic and non-sarcopenic (control) groups subjects was done. Results: There was an inverse relationship between expression of myostatin and vitamin D3 receptor genes (r = -0.345, P = 0.014). Both MSTN and VDR showed a significant positive and negative association with muscle state respectively (p<0.001). Conclusion: The reciprocal MSTN and VDR expression reflect their role in the regulation of muscle state, which opens a new challenge for them as preventive and therapeutic targets for sarcopenia.
[ABSTRACT]   Full text not available  [PDF]
  24 3 -
Iron Deficiency Anaemia and Quality of Life in Elderly
A Bamanikar, L Chatterjee, B Vaishnav, S Sharma, S Rana
April-June 2018, 14(2):53-57
Objectives: The study is aimed at assessing the effects of correction of iron deficiency anaemia on health related quality of life on patients treated with parenteral iron, and compares the effects of treatment with intravenous iron and placebo in a randomized controlled trial. Methods: Questionnaire based survey using (SF-8 short form) on health related quality of life in the elderly patients with iron deficiency anaemia (total 51, 2:1 randomised, blinded, control study) was carried out. Patients with severe cognitive or physical impairment were excluded. Observations were tested for significance level. Results: There was significant improvement in the domains of general health, bodily pain, vitality, social functioning, emotional role and overall improvement in physical and mental health as reflected by PCS and MCS scores. The domains of SF-8 with physical functioning, physical role, and mental health improvement were less impressive at 4 weeks as compared to the other five parameters of SF-8. There was no statistically significant difference in SF-8 items (HRQoL) before and after treatment with placebo. Conclusion: Elderly patients with iron deficiency anaemia have reduced HRQoL and parenteral iron treatment resulted in rapid improvements in HRQoL assessed at 4 weeks, significantly greater than placebo, across most of the domains.
[ABSTRACT]   Full text not available  [PDF]
  24 3 -
Prophylactic Chest Physiotherapy in Major Abdominal Surgery among Elderly Patients
ML Lohiya, Ajay Malviya, Dinesh Dutt Sharma, Sahi Ram, MK Chauhan, Lovedeep Singh Chauhan
April-June 2018, 14(2):64-68
Introduction: Chest physiotherapy has long been an established mode of treatment for pulmonary complications after major abdominal surgery. This study aimed to assess the effect of prophylactic chest physiotherapy on the frequency and severity of pulmonary complications following abdominal surgery. Material and Methods: A randomized controlled study of prophylactic chest physiotherapy was conducted among fifty post-operative patients (age > 60 years) who underwent elective open major abdominal surgery and were admitted in surgical ward of a tertiary care center. The patients were randomized into two groups: treatment group (n=25) and control group (n=25). The treatment group patients were given preoperative verbal information and informed consent was taken to undergo chest physiotherapy. In group A (n=15), patients performed incentive spirometry and in group B (n=10), patient performed breathing exercises with pursed lips, deep breathing and coughing hourly. In the control group (Group C, n=25), patients were not given any preoperative chest physiotherapy. Observations: The frequency of pulmonary complications was higher in group C (Atelectasis-12%, Basal pneumonia-28%, Pleural effusion-4%) in comparison to group A (Atelectasis-6.6%, Basal pneumonia-6.6%) and group B (Atelectasis-10%, Basal pneumonia-10%). The frequency of postoperative pulmonary complications after major abdominal surgery was less with spirometry (group A- 40%) compared to other physiotherapy (group B, 50%). Complications were maximum in patients without physiotherapy (group C- 72%). Conclusion: Prophylactic chest physiotherapy significantly reduces the frequency and severity of pulmonary complications following abdominal surgery.
[ABSTRACT]   Full text not available  [PDF]
  24 3 -
Delirium in Elderly General Medicine Inpatients: A Prospective Study
Meenaxi Sharda, Anuraj Singh, S Jelia, Nitasha Sharma, Jitendra Meena
April-June 2018, 14(2):69-73
Objective: To study all aspects of delirium including occurrence, risk factors, precipitating causes and outcome in tertiary care hospital catering geriatric medicine services. Methods: A prospective observational study was done among 100 cases of delirium recruited from 520 patients admitted in geriatric block of general medicine ward during a calendar year. Patients were screened for delirium by confusion assessment method. Prevalent delirium and incident delirium was calculated. A set of predisposing risk factors were sought on admission. The cause of delirium was ascertained after full evaluation of patients by taking history, doing physical examination including neurological examination and appropriate investigations. Outcomes were measured in terms of length of hospital stay and inpatient mortality. Results: Out of 520 patients admitted in Geriatric ward during the study period, 100 patients had delirium (study prevalence 19.23%) and out of these, 7 patients developed delirium during hospitalization (study incidence 1.34%). The most common precipitating causes of delirium was infections (41%), followed by stroke (17%) and electrolyte imbalance (11%). Among infections, UTI was the most common cause. The most common predisposing risk factors for delirium were infections (52%), sensory impairment (51%), immobility/ being bedridden (40%), incontinence (32%), hypoxia (29%), electrolyte disturbances (hyponatremia- 22%), dehydration (21%), and poly pharmacy (15%). At the end of the study, mortality was 24% and 38 (38%) patients were recovered from the delirium. Conclusion: Delirium was found in 19.23% admitted geriatric patients and associated with considerable mortality (24%). The most common precipitating and predisposing causes of delirium was infection. After effective management, 38 (38%) patients recovered from delirium and were discharged in stable condition.
[ABSTRACT]   Full text not available  [PDF]
  24 3 -
Projection of Life Expectancy at Birth of Malaysian Population: A Modelling Approach
Md. Rafiqul Islam, Mahendran Shitan, Md. Nazrul Islam Mondal
April-June 2017, 13(2):68-72
The purpose of this study is to project life expectancies (LEs) by sexes and ethnic groups for Malaysia. The secondary data of LE by sex and ethnic groups for Malaysia were extracted from the Department of Statistics, Government of Malaysia. The exponential growth model was employed to fulfill the objective. Projections of LEs for male and female of Malaysia by ethnicity were estimated by using exponential growth model for the years 2014-2050. The study investigated that the LEs for male and female of Malaysia by ethnicity are showing increasing trend. Results revealed that LEs for the female is greater than that of the male for each ethnic group. The projected LEs for male and female of Malaysia in 2050 would be 79.13 and 84.05 years, respectively. The population of Malaysia will tend to live long. The Government should have clear information about the number of elderly population ensuring their healthy environment.
[ABSTRACT]   Full text not available  [PDF]
  24 3 -
Translation and Cross-Cultural Adaptation of the Activities-Specific Balance Confidence (ABC) Scale for use in Maharashtra
UR Sahu, VN Kulkarni
April-June 2017, 13(2):73-76
Introduction: This study aimed to translate and culturally adapt the Activities-Specific Balance Confidence (ABC-M) Scale for use in Maharashtra, India and to assess its usability on elderly. The ABC Scale is a 16-item questionnaire. Each item is rated from 0% (no confidence) to 100% (complete confidence). Elderly respondents are asked to rate their confidence that they will lose their balance or become unsteady in the course of daily activities. Method: The methodological procedure of translation and cultural adaptation by WHO was followed: Forward translation, expert panel back-translation, pre-testing and cognitive interviewing, and final version Results: The process of translation and cultural adaptation was considered adequate. The procedure resulted in simple grammatical modifications for the items and 20 subjects were examined for the pre-test. Conclusions: The study resulted in successful translation and adaptation of the ABC scale in Marathi (ABC-M).
[ABSTRACT]   Full text not available  [PDF]
  24 3 -
CASE REPORT
Fluorosis: An Uncommon Cause of Quadriparesis
R Beniwal, A Shekhawat, LK Goyal, R Prasad, P Mittal
April-June 2017, 13(2):90-93
Fluorine is a double edged sword as its higher levels are linked with dental/skeletal fluorosis while its deficiency is associated with dental caries.1 Skeletal fluorosis may remain asymptomatic or may present with myeloradiculopathy secondary to cord compression and nerve root involvement. Neurological complication including quadriparesis is a rare complication of endemic fluorosis. Since the changes of dental and skeletal fluorosis are irreversible, prevention is the mainstay of controlling the disease.
[ABSTRACT]   Full text not available  [PDF]
  22 4 -
ORIGINAL ARTICLES
Advance Directives among Elderly Population: A Malaysian Experience
TL Koh, CS Lei, TR Tajudin, Z Abdulshakur
April-June 2017, 13(2):62-67
Objective: As not many studies have been done on the topic of advance directives in Malaysia and it has yet to gain awareness among our population, we realised the need for a study to be done not only to delineate the prevalence and preference but also to raise the level of awareness. Methods: In 2015, we carried out a descriptive, cross-sectional study that targeted elderly population residing in six nursing homes and two senior activity centres in Muar. Muar a.k.a "Bandar Di Raja" is a town geographically located in the north-west region of Johor state. Data was collected through a 14 item structured questionnaire which was divided into two sections; socio-demographic profile, prevalence and preference of advance directives. Results: The response rate for this study was 50% where a total of 70 respondents out of the 150 residents participated. Non-participation was due to the exclusion criteria. 11.4% of the respondents had heard of advance directives, but none so far have an advance directive. Among the respondents, 70% of them are open to the concept of having an advance directive. For the remaining 30% that were against the use of advance directives, 38.1% of them prefer to have decisions done by the doctors. With regards to the recording of advance directives, the verbal promise was the most favored option chosen. As for the preferences for end-of-life treatment, the majority (51%) opted for comfort care with only pain medication. Conclusion: The prevalence of advance directives in Malaysia is progressing at an extremely slow pace, but it also showed that the elderly population are receptive to the concept of an advance directive. To promote the advancement of advance directives, the level of public awareness needs to be raised through primary care centres and awareness campaigns.
[ABSTRACT]   Full text not available  [PDF]
  24 2 -
REVIEW ARTICLE
An Overview of Frailty in Elderly
M Shaheen, S Puri, N Tandon
April-June 2016, 12(2):58-65
Frailty is an ageing phenomenon and it becomes essential to understand frailty, its causes and consequences as well as the risk factors that will enable us to plan appropriate interventions to target elderly who are at risk and thus preventing them from developing frailty. Frailty is linked with multiple morbidities and it adds on to the burden of the disease on the elderly making them dependent for their basic activities of daily living further deteriorating their overall quality of life. Limited studies have been done to determine association of frailty with nutritional status in the western countries, but in developing countries like India, where the elderly population is increasing at a faster pace; there is a dearth of information regarding the prevalence rates and the associated risk factors. This article attempts to provide an overview of frailty in elderly which may help create awareness among the older age groups and in focusing the attention of the healthcare providers in preventing this phenomenon to reduce the health care costs in our country.
[ABSTRACT]   Full text not available  [PDF]
  22 4 -
CASE REPORT
Parathyroid Adenoma in an Elderly Patient with Unusual Presentation
Rajeswari Sunku, Ravikant Khande
October-December 2016, 12(4):183-184
Full text not available  [PDF]
  22 3 -